Resurfacing for AVN-hip: Vijay Bose et al..

Comments

1. bimal says

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   of course, resurfacing works well when vijay bose does it , but i would like to note down few points about bearings ..would be great if all u guys can add on ..i beleive i ve posted this earlier here somewhere..dunno where!!)

   1)when to choose high end bearing;-
   high end bearings (COC, MOM,COM)to be considered only if you have a combination of both “high demand hip” and “well versed surgeon” is there.. key point is both ..not either (as it was in past).
   its cuz an ALVAL or sqeuaking in a low demand hip can be legally challeneged with the data available now from the retrieval analysis of revsions and the question will be about the competency of the surgeon and wether the patient really needed the bearing

   2)the changing trend in problems with high end bearings;
   the trend in COC has moved from fractures to squeaking . the new biolox delta ceramic has decreased the head fracture incidence but incidence of squeaking is been reported as high as 7 % in certain series
   the trend in MOM is shifting from systemic toxicity (due to high metal ions in circulation) to local reactions like ALVAL & pseudo-tumors. the point to be noted that revisions done in ALVAL and psuedo tumour hips have poor prognosis than revisions done for other causes
   MOM also squeak and COC can also have psuedo tumours

   3) if in old metal on poly the problems started after first 5 to 7 yrs, in hard on hard bearing the real time is first 2- 3 yrs
   during the “bedding in” period of hard on hard bearing (roughly 2 yrs) dont hesitate to do an MRI ( for psuedo tumours and version) for a painfull hip or a CT to rule out mal- alignment in a squeaking hip. earlier revised the better. also not a bad idea to ask the patient to keep a avoid extreme actions for first two years

   4) females always avoid MOM, if the decision if for resurfacing beware of CAVA angle. resurfacing is not dead yet and “if works has best results”.

   5) if ur given a normal demand hip and you are a surgeon with not high numbers in hard on hard,….go for MOP or COP. cross linked poly does produce quantitavely less wear put the qualitatively the wear particles generated are very osteolytic. insist on minimum of 8 mm poly and make it mandatory to check the shelf life of poly (shelf life and poly thickness has strong association to wear potential)

   this s my take on bearings…wht bt all of u?

2. manan says

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   the old news on the block is johnson n johnson have withdrawn birmingham hip from india beacuse the implant has been implicated in contributing to the destruction of bone in the femoral head.
   so does this mean that resurfacing implants are on the downside? or that they are not a reliable treatment option anymore?

3. admin says

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   Can someone update on the Recent Ghent symposium held in belgium.It is one of the largest resurfacing meetings across the globe.And Dr Vijay Bose is one of the faculty..?

4. vijay bose says

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   I fully agree with all the comments made by Dr. Bimal. It is increasingly becoming obvious that the more the high performance the bearing – the narrow is the corridor of safety as regards implant posiitioning.
   Hence a hard on soft would be the safest bearing as regards implant positioning and one must have a ‘good reason” to use a high performance bearing. In other words taking unnecessary risks is never an wise idea.

   Dr Vijay Bose
   Resurfacing Hip Surgeon
   Apollo Speciality Hospital
   chennai

5. admin says

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   Folks,
   FOr those who do not know who Dr Vijay Bose is.!Well, he is one of the most popular hip resurfacing surgeons across the globe. Trained under Dr Derek McMinn. Has trained surgeons all over India and abroad. He has one of the single largest series of Hip Resurfacing for AVN Hip. Most of his patients are from US and other countries. When he says about “safe corridor”, he really means it and achieves it.

   Thank you sir for your comments..

6. bimal says

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   Dr. Bose, thanks for your comments.. really great to hear from the master himself….

7. Admin says

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   Also read,

   http://www.hipresurfacingnews.com/categories/26-Articles-2010

8. bimal says

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   McMinn is very critical of ASR here… in same web page there s a nice write up by Bose where he explains the in built problem with ASR and why he never had issues with it……

   http://www.hipresurfacingnews.com/archives/346-Dr.-Bose-Discusses-the-ASR-Withdrawal.html

   ………. but McMinn quote is so very true “if you want a MOM device to fail, implant it badly or design it badly”